| Shadow And Light Wellness Llc | |
|
919 S 25th E Ammon ID 83406-5731 | |
| (208) 227-3571 | |
| Not Available |
| Full Name | Shadow And Light Wellness Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 919 S 25th E, Ammon, Idaho |
| Authorized Official Name and Position | Samantha Darlene Hodge-tracy (OWNER/COUNSELOR) |
| Authorized Official Contact | 2082273571 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shadow And Light Wellness Llc 785 Terrace Dr Idaho Falls ID 83402-3113 Ph: (208) 227-3571 | Shadow And Light Wellness Llc 919 S 25th E Ammon ID 83406-5731 Ph: (208) 227-3571 |
| NPI Number | 1023823531 |
|---|---|
| Provider Enumeration Date | 02/11/2025 |
| Last Update Date | 02/11/2025 |
| Certification Date | 02/11/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023823531 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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